Cognitive-Behavioral Therapy: A Case Report -- Animal-Assisted Therapy

Janet Eggiman, BSN, MSN


October 12, 2006

In This Article

Case Study: Annie, a 10-Year-Old With a History of Abuse

Annie was a 10-year-old girl who presented for therapy with her foster mother. Her presenting problems included lying, stealing, hyperactivity, sexually acting out with the family dog, masturbating, aggressive behaviors with her siblings, temper tantrums, enuresis, and an inability to become calm and relaxed. Her history included chronic sexual abuse by her stepfather (which usually occurred in the bathtub during the night), physical abuse, nightmares, panic when seeing men who looked like her stepfather, hypervigilance at night, inability to concentrate, hyperactivity, and numbing of feelings. These behaviors meet the criteria for PTSD in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).[24]

The initial treatment goals for Annie were:

  • Provide a sense of safety;

  • Stabilize her mood;

  • Manage her aggressive behaviors;

  • Increase her attention span and ability to focus; and

  • Eliminate her sexual acting-out behaviors.

Because Annie had a history of sexually acting out with animals, hurting animals, and aggression toward her siblings, Kotter was not introduced until she understood the rules for interaction with Kotter. This was done for her sense of safety, her ability to comply with rules, and for Kotter's safety. Because she was anxious to meet the dog and saw this as a reward, she first showed adherence to playroom rules.

Her first session with Kotter was structured as follows: the explanation of Kotter's rules, her expressed agreement with the rules, the introduction of Kotter and her getting to know him, petting Kotter and staying relaxed, talking to Kotter, telling a therapeutic story about Kotter's behavior, and telling him goodbye.

Kotter's rules were as follows:

  1. Allow him to sniff the back of your hand first;

  2. Stay calm and still;

  3. Pet him only on his muzzle, head, ears, back, and paws;

  4. Only the (therapist) handler gives him commands, unless you are given permission to give him a command;

  5. Always be gentle;

  6. Do not feed him unless the therapist gives you a treat to give him; and

  7. Do not get loud or rough.

Annie's behaviors before and after the introduction of Kotter were observed and were as follows.


  • Constant body movements that included walking around the room, touching everything, opening desk drawers, and trying to take things, such as crayons, pencils, and stuffed animals;

  • Constant talking with an inability to focus on one topic;

  • Difficulty following rules;

  • Difficulty remaining calm, balanced — despite efforts to institute relaxation techniques;

  • Could not identify feelings or show empathy for anyone who she hurt;

  • Appeared rough and uncaring; and

  • Did not respect boundaries or personal space.

During her first session with Kotter, the following behaviors were observed:

  • Sat quietly on the floor with Kotter's head in her lap;

  • Listened to a therapeutic story and then drew a picture of her foster family;

  • Followed every rule with regard to Kotter;

  • Muscle relaxation was noted;

  • Shared thoughts and feelings about her mother;

  • Was gentle and caring with Kotter; and

  • Petted Kotter according to the rules.

In subsequent sessions with Kotter, Annie was able to disclose more memories of abuse in this safe and secure atmosphere. Since this time, her behavior at home and at school has been reported to be improved. At night, her foster mother reminds her of the feelings of calmness while with Kotter. This seems to have reduced her anxiety at night, enabled her to sleep, and not disturb her siblings.

Her ability to follow rules and structure in session with Kotter allowed her to use these skills in completing homework assignments during homework time and follow the rules that her foster parents established around bedtime activities. Her foster mother reported that when Annie was introduced to a Shih Tzu, the dog of a family friend, she announced that no one could hurt the dog by hitting or poking it and she demonstrated ways to pet the dog — just like she petted Kotter.

Annie is still struggling with aggressive behaviors with her siblings and peers at school. However, she has not been aggressive toward Kotter and is always gentle.


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